Liver dysfunction associated with artificial nutrition in critically ill patients

Grau, T.; Bonet, Alfons; Rubio, M Valera; Mateo, D; Farré, Mercè; Acosta, José A.; Blesa, A.; Montejo, Juan Carlos; Lorenzo, A. García de; Mesejo, A.

doi:10.1186/cc5670

Cited by 152 publications

(29 citation statements)

References 38 publications

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“…Likewise, the results of a multicentre study by Grau et al . showed no impairment of liver function within the first six days of TPN [ 57 ]. In the light of these findings we do not attribute any major role to TPN in the pathogenesis of SSC-CIP in our patients.…”

Section: Discussionmentioning

confidence: 99%

Trigger mechanisms of secondary sclerosing cholangitis in critically ill patients

et al. 2015

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IntroductionIn recent years the development of secondary sclerosing cholangitis in critically ill patients (SSC-CIP) has increasingly been perceived as a separate disease entity. About possible trigger mechanisms of SSC-CIP has been speculated, systematic investigations on this issue are still lacking. The purpose of this study was to evaluate the prevalence and influence of promoting factors.MethodsTemporality, consistency and biological plausibility are essential prerequisites for causality. In this study, we investigated the temporality and consistency of possible triggers of SSC-CIP in a large case series. Biological plausibility of the individual triggers is discussed in a scientific context. SSC-CIP cases were recruited retrospectively from 2633 patients who underwent or were scheduled for liver transplantation at the University Hospital Charité, Berlin. All patients who developed secondary sclerosing cholangitis in association with intensive care treatment were included. Possible trigger factors during the course of the initial intensive care treatment were recorded.ResultsSixteen patients (68% males, mean age 45.87 ± 14.64 years) with a confirmed diagnosis of SSC-CIP were identified. Of the 19 risk factors investigated, particularly severe hypotension with a prolonged decrease in mean arterial blood pressure (MAP) to <65 mmHg and systemic inflammatory response syndrome (SIRS) were established as possible triggers of SSC-CIP. The occurrence of severe hypotension appears to be the first and most significant step in the pathogenesis. It seems that severe hypotension has a critical effect on the blood supply of bile ducts when it occurs together with additional microcirculatory disturbances.ConclusionsIn critically ill patients with newly acquired cholestasis the differential diagnosis of SSC-CIP should be considered when they have had an episode of haemodynamic instability with a prolonged decrease in MAP, initial need for large amounts of blood transfusions or colloids, and early development of a SIRS.

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Section: Discussionmentioning

confidence: 99%

Trigger mechanisms of secondary sclerosing cholangitis in critically ill patients

et al. 2015

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“…Recently, the SPN trial showed that this individualized energy supply obtained by EE measurement in 65% of patients was rewarding in terms of reduction of nosocomial infections in severely ill ICU patients requiring prolonged ICU treatment [ 38 ]. Grau and colleagues have shown that liver alterations (defined as cytolysis, cholestasis or a combination of both) during enteral or parenteral feeding occur frequently if energy delivery exceeds 27 kcal/kg/day, and add to those liver alterations caused by sepsis and multiple organ failure [ 42 ]; the difference becomes significant after day 11 in patients on PN, ED producing less alteration related to lower energy intakes.…”

Section: Energy Requirementsmentioning

confidence: 99%

Development and current use of parenteral nutrition in critical care – an opinion paper

Berger

Pichard

2014

Crit Care

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Critically ill patients depend on artificial nutrition for the maintenance of their metabolic functions and lean body mass, as well as for limiting underfeeding-related complications. Current guidelines recommend enteral nutrition (EN), possibly within the first 48 hours, as the best way to provide the nutrients and prevent infections. EN may be difficult to realize or may be contraindicated in some patients, such as those presenting anatomic intestinal continuity problems or splanchnic ischemia. A series of contradictory trials regarding the best route and timing for feeding have left the medical community with great uncertainty regarding the place of parenteral nutrition (PN) in critically ill patients. Many of the deleterious effects attributed to PN result from inadequate indications, or from overfeeding. The latter is due firstly to the easier delivery of nutrients by PN compared with EN increasing the risk of overfeeding, and secondly to the use of approximate energy targets, generally based on predictive equations: these equations are static and inaccurate in about 70% of patients. Such high uncertainty about requirements compromises attempts at conducting nutrition trials without indirect calorimetry support because the results cannot be trusted; indeed, both underfeeding and overfeeding are equally deleterious. An individualized therapy is required. A pragmatic approach to feeding is proposed: at first to attempt EN whenever and as early as possible, then to use indirect calorimetry if available, and to monitor delivery and response to feeding, and finally to consider the option of combining EN with PN in case of insufficient EN from day 4 onwards.

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“… Multivariate model A multiple linear regression model was constructed to study the relationship between each LFT variation as a continuous variable and the amount of FO given adjusted in accordance with four important variables of liver co-morbidity: Presence of sepsis when each liver parameter presented the highest value. According to the American College of Chest Physician/Society of Critical Care Medicine (ACCP/SCCM) consensus conference, sepsis was established when the patient presented at least two of the following criteria: (a) body temperature ≥38 °C or ≤36 °C, (b) tachycardia with heart rate ≥90 beats/min, (c) tachypnea with paCO 2 ≤ 32 mmHg or mechanical ventilation; (d) leukocytes >12x10 9 cells/L [ 14 ]. LOS in ICU considered as the number of days that the patient stayed in ICU.…”

Section: Methodsmentioning

confidence: 99%

The relationship between the parenteral dose of fish oil supplementation and the variation of liver function tests in hospitalized adult patients

Badia-Tahull

Leiva‐Badosa

Jódar-Masanés

et al. 2015

Nutr J

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BackgroundHepatic dysfunction is a complication associated with parenteral nutrition (PN). Our primary objective was to study the relationship between doses of intravenous fish oil (FO) emulsion in PN and the variation in the main liver function tests (LFTs) in hospitalized PN-treated adults. As a secondary objective, we studied the safety of FO administration.MethodsWe conducted a retrospective study in adult patients receiving FO supplementation in PN. Demographic, nutritional and safety variables were collected. Variation of LFTs was defined as the difference between values just before the first administration of FO and values at the end of PN. A multiple linear regression was performed to study the association between PN-lipids (FO or vegetable) and the variation of each LFT; the following variables were used to adjust the effect of lipids: sepsis, length of stay in the intensive care unit and lipids dose. Student t-test was used to study safety variables. Data were analyzed using SPSS 19.0.ResultsPatients (53, median age 68 years (24–90); 62 % men) with the principal diagnosis of digestive neoplasm (42 %) received PN for a median of 19 (7–75) days. In the multivariate analysis, the amount of FO was related to a decrease in gamma-glutamyl transferase (GGT) (B = −2.23;CI95 % = −4.41/-0.05), a decrease in alkaline phosphatase (AP) (B = −1.23;CI95 % = −2.07/-0.37), and a decrease in alanine aminotransferase (ALT) (B = −0.82; CI95 % = −1.19/-0.44). No differences were found in safety variables.ConclusionsGGT, AP and ALT improved with FO PN-supplementation. Moreover, the improvement was greater when the doses of FO were higher. FO administration in PN is safe.

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Liver dysfunction associated with artificial nutrition in critically ill patients

Abstract: Introduction Liver dysfunction associated with artificial nutrition in critically ill patients is a complication that seems to be frequent, but it has not been assessed previously in a large cohort of critically ill patients.

Cited by 152 publications

References 38 publications

Trigger mechanisms of secondary sclerosing cholangitis in critically ill patients

Trigger mechanisms of secondary sclerosing cholangitis in critically ill patients

Development and current use of parenteral nutrition in critical care – an opinion paper

The relationship between the parenteral dose of fish oil supplementation and the variation of liver function tests in hospitalized adult patients

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